Expert Point of View: Sumanta Pal, MD


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Sumanta Pal, MD

Sumanta Pal, MD

LATITUDE Trial

ASCO expert Sumanta Pal, MD, of the City of Hope Comprehensive Cancer Center in Duarte, California, commented on the LATITUDE trial at a press conference. “In 2014, docetaxel added to hormonal therapy showed an improved survival benefit in two trials—CHAARTED and STAMPEDE. It was no small feat to show this. However, docetaxel is associated with more toxicity [than abiraterone (Zytiga)], especially in older men,” Dr. Pal noted.

“Abiraterone is an important alternative to chemotherapy. It is a more potent drug than docetaxel. Although it is challenging to compare the data on docetaxel with those on abiraterone, at first glance it appears that the survival benefit with abiraterone mirrors that of docetaxel. Abiraterone has far fewer side effects than docetaxel,” Dr. Pal continued.

“These data should reshape our model for treating metastatic prostate cancer. Abiraterone with conventional hormone therapy should become a new standard of care for men with high-risk metastatic prostate cancer. We need to examine whether there remains a role for chemotherapy in this setting,” he stated. 

STAMPEDE Trial

“It is good to have multiple studies,” admitted ASCO expert Sumanta Pal, MD, of the City of Hope Comprehensive Cancer Center in Duarte, California. “These findings are congruent with those of LATITUDE. STAMPEDE uses a highly unique treatment paradigm, with an efficient strategy that allows us to build on existing strategies. Several years ago, the STAMPEDE investigators showed that docetaxel improved survival building on the same backbone.”

The key difference between the LATITUDE and STAMPEDE trials is the inclusion of patients with nonmetastatic prostate cancer in -STAMPEDE. “Since the Forest plot shows the confidence interval for nonmetastatic disease straddles 1.0, the study does not completely define the benefit of abiraterone in nonmetastatic disease. Based on these results, further study is needed to determine a role for abiraterone in nonmetastatic disease,” Dr. Pal declared.

“These findings should change the standard of care [to abiraterone] for patients with metastatic disease,” Dr. Pal added. ■

DISCLOSURE: Dr. Pal reported no conflicts of interest.

 


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